In 2009, allegations that insulin causes cancer grabbed headlines. Experts from the American Diabetes Association and American Cancer Society evaluated this relationship but could neither confirm nor deny it. “Many patients with diabetes stopped taking their medications because of these unfounded allegations,” says Yehuda Handelsman, MD, FACP, FACE, FNLA. Recently, a task force from the American Association of Clinical Endocrinologists and American College of Endocrinology reviewed the roles of obesity and diabetes and their therapies in the context of the pathogenesis of cancer and published a consensus statement on the topic in Endocrine Practice. Assessing the Link It may generally take as long as 10 to 50 years for cancer to develop after a cell is exposed to a carcinogen. “Many of the allegations suggesting that diabetes medications may be responsible for the development of cancer were based on exposure of 6 to 24 months, making their role unlikely,” says Dr. Handelsman. Many of the publications implicating insulin in the increased long-term cancer risk were based on retrospective data on 3 to 5 years of insulin exposure. The statement also notes that obese patients are at increased risk for cancer when compared with the general population, and patients with diabetes have a slightly higher risk of cancer than obese patients. As such, the task force recommends that patients with diabetes or obesity be screened early for cancer. It also recommends that young adults with cancer be screened for metabolic conditions. With no direct relationships between diabetes medication and cancer development being proven, Dr. Handelsman says there is no reason for physicians to change how they manage diabetes, and patients...

Hospital readmissions are important contributors to total medical expenditures in the United States and are an emerging indicator of quality of care. “CMS has started to reduce reimbursement for patients who are rehospitalized early for several conditions, but diabetes currently isn’t one of those diseases,” says Kathleen M. Dungan, MD, MPH. “However, it’s known that diabetes is associated with a higher risk for hospital readmission, and while it may not be the primary reason for admission, it is a frequent comorbidity.” Studies suggest that 20% of patients with diabetes are rehospitalized within 30 days of discharge, and 30% of these individuals are hospitalized more than once a year. There were 7.7 million hospital stays for patients with diabetes in the U.S. in 2008, accounting for 20% of hospitalizations and $83 billion in costs. Research has shown that rehospitalizations occur disproportionately among socioeconomically disadvantaged groups, including Hispanics and African Americans, those living in lower income areas, and those without private insurance. Other risk factors include previous hospitalizations, extremes of age, and socioeconomic barriers. Failing to acknowledge diabetes at discharge raises the risk of early hospital readmissions, says Dr. Dungan. Examining the Literature Some studies have suggested that involving diabetes specialist teams may reduce readmission rates, but results can vary depending on the individual components of the program and attention to discharge needs. Typically, inpatient diabetes management teams incorporate some component of diabetes education, but Dr. Dungan says many hospitals have inadequate funding or resources to optimize this treatment strategy. “Patient education for diabetes is often thought of as being most effective when delivered in the outpatient setting,” she says. “However,...

When someone with diabetes comes into my office, he or she doesn’t see me until after meeting with a diabetes educator. In fact, each patient spends 40 minutes with the diabetes educator during the course of their appointment with me. That gives the patient time to learn detailed information about different aspects of their diabetes management. It also gives them a chance to become more informed about each decision and ask plenty of questions. This allows me to focus on what I love most, the patient’s whole health. The diabetes educator is an integral member of our care team at Sutter Health, which is why this approach works. We use an electronic medical record to share and view treatment information in real time. The diabetes educator answers questions for patients between office visits. They help identify the need for insulin dose adjustments and provide classes on diabetes self-management, heart health, weight loss, prediabetes, and more. Our patients truly appreciate being able to work directly with a diabetes educator as part of the care we provide them. They love that the educator has the time and expertise to help them manage their diabetes. The educator also helps me and my physician partner care for greater numbers of patients with the condition—a fundamental piece to our success. Physicians should recognize the value of diabetes educators when it comes to managing patients with the disease. Published guidelines recommend using diabetes educators in the course of care, and clinical studies further support the benefits of integrating them into the care team. By utilizing these valuable resources, we have the opportunity to improve how...

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